Abstract Background To gain more insight into the involvement of inflammatory response and neurohumoral activation in Takotsubo cardiomyopathy (TTC), we investigated C-reactive protein (CRP), ...leukocytes, plasma catecholamines levels, iodine 123 meta-iodobenzylguanidine (123 I-mIBG) myocardial uptake, myocardial perfusion (thallium 201 201 Tl or technetium Tc 99m-tetrofosmin myocardial single photon emission computed tomography SPECT), and metabolism (fluorine 18-fluorodeoxyglucose positron emission tomography). Methods and Results Inflammatory status and brain natriuretic peptide (BNP) levels in 17 patients with TTC were compared with 14 age-matched patients. In TTC, elevated levels of CRP were evidenced on admission, reaching a peak in the following days ( P < .01). CRP levels were correlated to baseline left ventricular ejection fraction (LVEF) and BNP levels ( P < .05). Leukocytes were correlated to BNP and noradrenaline levels. Myocardial123 I-mIBG SPECT showed a reduced activity in the midventricle and apex corresponding to 35% ± 23% of the total myocardial mass, partially reversible at follow-up. An identical pattern was retrieved when assessing myocardial glucose metabolism. At rest, no relevant abnormalities of myocardial perfusion could be evidenced at the subacute phase. Conclusion Inflammatory status in TTC was related to LVEF impairment and to the extent of neurohormonal activation. The hypothesis of a catecholamine-induced myocardial “stunning” is emphasized by the evidence of a reduced123 I-mIBG myocardial activity, impairment of myocardial glucose metabolism, and wall motion kinetic after the same temporospatial distribution.
Clopidogrel 150 mg/day to Overcome Low Responsiveness in Patients Undergoing Elective Percutaneous Coronary Intervention: Results From the VASP-02 (Vasodilator-Stimulated Phosphoprotein-02) ...Randomized Study Boris Aleil, Laurent Jacquemin, Fabien De Poli, Michel Zaehringer, Jean-Philippe Collet, Gilles Montalescot, Jean-Pierre Cazenave, Marie-Claude Dickele, Jean-Pierre Monassier, Christian Gachet A randomized, open-label trial investigated the effects of clopidogrel 150 mg/day maintenance therapy on platelet inhibition. Elective percutaneous coronary intervention patients were randomized to 4 weeks of treatment with either clopidogrel 150 mg/day or 75 mg/day. After 2 weeks, low responders to clopidogrel 75 mg/day were switched to clopidogrel 150 mg/day. At 2 weeks, clopidogrel 150 mg/day was associated with a signficantly lower platelet reactivity index and a significantly lower proportion of low responders compared with patients at 75 mg/day. Sixty-four and one-half percent of low responders to clopidogrel 75 mg/day became responders to 150 mg/day. These findings suggest a potential benefit of switching low responders to clopidogrel 75 mg/day to clopidogrel 150 mg/day.
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